A trocar is a surgical instrument, contained in a sheath that is used for making a bodily incision. In typical procedures, the inner portion of the trocar is removed from the incision and the surrounding sheath is left in place so that surgical tools may be inserted into the incision. A laparoscope, which is one class of an endoscope, is an example of such a tool. Typically, a laparoscope includes a rigid elongated sheath tube which encloses a image transferring means channel which receives a fiber optic image light bundle or relay lens system. The image transferring means channel is typically surrounded by fiber optic light carrying means. The distal end of the laparoscope is used to develop an optical image of an operating site within a cavity and the operating site is illuminated by light which is carried to the operating site by the fiber optic light carrying means. The optical image is transmitted through the image transferring means to the proximal end of the laparoscope where a viewable image is observed by the surgeon. The state-of-the-art laparoscopes are usually inserted through a cannula and trocar assembly which makes an incision or opening in the navel or belly-button of a patient. The purpose of making the incision in the navel or belly-button is to minimize the appearance of the surgical scar which remains upon completion of the surgical procedure. It is also known in the act to utilize a primary cannula and trocar assembly to form the initial opening through the navel or belly-button into the abdomen or the peritoneal cavity and use smaller cannula and trocar assemblies which are inserted into other smaller incisions to provide access to the peritoneal cavity for passing working tools. In the known laparoscopic procedures, the peritoneal cavity is insufflated with an appropriate fluid (gas) such as carbon dioxide (CO2) gas, concomitant with laparoscopic or peritoneoscopic examination, diagnosis and/or treatment, including the excision of structure and tissues in the peritoneal cavity. In the recent past, the type of surgeries performed using laparoscopic procedures has been expanded into new minimum invasive surgical procedures. One such new procedure utilizes the laparoscope, with other appropriate instruments, for performing laparoscopic cholecystectomy which is essentially a minimum invasive surgical method for removal of a gallbladder. Similar minimum invasive surgical techniques are being developed using laparoscopes to remove other organs, such as the appendix, kidney or tissues, such as from the liver, also located in the peritoneal cavity (etc.).
It is also known in the art that when utilizing a laparoscope in a laparoscopic procedure, such as, for example, the laparoscopic cholecystectomy briefly described above, it is necessary that the distal lens be free from light impeding agents such as a layer of fog, protein material or organic material. It is the desire of the surgeon to keep the laparoscope in the peritoneal cavity at all times.
However, it is known that when the distal tip of the laparoscope is inserted into the peritoneal cavity, a fogging occurs across the distal tip which impedes the passage of the optical image and which interferes with the ability of the surgeon to view the operating site. This fogging condition is due to the fact that the operating room temperature is in the order of 20 degrees C. (68 degrees F.). However, the interior of the peritoneal cavity or abdomen is generally at blood temperature which is typically in the order of 37 degrees C. (98.6 degrees F.). Thus, when a laparoscope, which is maintained at room temperature in the operating room which is typically 20 degrees C. has the distal tip thereof at room temperature of about 20 degrees C. inserted into the abdomen having a temperature of approximately 37 degrees C., the temperature differential therebetween is sufficient to cause instant fogging of the distal lens.
Once known method for solving this problem is to heat the distal tip of the laparoscope by a variety of means. One method that is utilized to heat the distal tip is to insert the distal tip into a container of hot water to raise the temperature of the distal tip to approximately 37 degrees C. Another known technique is to place the distal tip in hot towels to raise the temperature thereof to approximately 37 degrees C.
In addition to the above fogging problem, other image impeding programs are encountered during a procedure. When a surgeon is performing a procedure, that procedure normally results in particulate matter such as protein, blood, tissue and the like, begin splattered through the operating site during the procedure. Typically, certain of the particulate matter will adhere to the distal surface and transparent member located at the distal tip of the laparoscope thereby impeding the transmission or passage of the optical image through the transparent member. This is particularly true during use of laser and electroncautery procedures for removing tissue.
In a typical laparoscopic procedure, particulate matter accumulates on the distal end three or four times during a procedure. Each time the optical image is impeded by the accumulation of particulate matter, it is necessary for the surgeon to remove the laparoscope through the cannula and trocar assembly, to physically wipe the particulate matter off of the transparent member, located at the distal tip of the laparoscope, and then reinsert the laparoscope through the cannula and trocar assembly back into the abdominal or peritoneal cavity to continue the procedure. For this reason, a method of removing particulate matter from a laparoscope, or other endoscopic tool, while it remains in place is desirable.
Tools having suction and irrigation features are known in the art for endoscopic applications. Recently, combined suction-irrigation tools with additional features have been developed. U.S. Pat. No. 4,617,013 to Betz discloses a “Method and Apparatus For Surgical Irrigation, Aspiration and Illumination” having coaxial fiber optic, aspiration an irrigation tubes. The fiber optic is used for providing lighting. No laparoscope is present in the device; therefore, the suction and irrigation features do not clean a laparoscope housed within. U.S. Pat. No. 4,207.874 to Choy discloses a “Laser Tunneling Device” which is a probe for a tube such as a blood vessel. The probe includes central fiber optics for illumination, viewing and laser output surrounded by a coaxial tube with a switchable valve for aspiration or irrigation. The irrigating fluid is a dye used to locate an obstruction, and suction is used to remove vaporized debris produced by laser action on an obstruction.
While many of the tools of the prior art served a purpose that the time they were invented, they are generally inapplicable in today's modem endoscopic surgical procedures. An endoscopic procedure typically involves the use of trocars for making one or more small incisions in the abdomen or chest cavity. Trocar tubes are then left in place in the abdomen or chest cavity so that optical tools may be inserted therethrough for viewing and endoscopic surgical tools may be inserted therethrough for operating. A camera or magnifying lens optical tool is often inserted through the largest diameter trocar tube (e.g. 10 mm diameter) while a cutter, dissector, or other surgical instrument is inserted through a similarly sized or small diameter trocar tube (e.g. 5 mm diameter) or purposes of manipulating and/or cutting the internal organ. Sometimes it is desirable to have several trocar tubes in place at once in order to receive several surgical instruments. In this matter, organ or tissue may be grasped with one surgical instrument, and simultaneously may be cut or stitched with another surgical instrument; all under view of the surgeon via the camera in place in another trocar tube.
Those skilled in the art will appreciate that endoscopy is a rapidly growing field of surgery because it is less invasive than classical surgery. However, it will also be appreciated that even with endoscopic surgery where the incisions are typically small, it is advantageous to limit the number of incisions made. The number of incisions must be balanced against the desirability of having several tools inserted and available simultaneously to the surgeon. Likewise, while it is possible to remove endoscopic tools and insert different tools during a procedure, it will be appreciated that repeated insertion and removal of different endoscopic tools through the trocar tubes is preferably avoided, as it can be difficult to locate the new tool at a desire location, and each insertion of a tool increases the risk of unnecessary trauma to the surgical site area.
Some attempts have been made to provide multi-functional endoscopic tools so that the number of incisions may be minimized while at the same time providing the physician with several tools available simultaneously. For example, U.S. Pat. No. 4,708,136 to Saito discloses a “Cautery Hemostatic Unit” which is deliverable through an endoscope and includes an irrigation nozzle. Other combination endoscopic tools are known and generally include combination suction-irrigation and suction-cautery probes. All of these probes occupy a trocar tube when in use and no other tool may be inserted in the trocar when occupied by one of these probes. Additional combinational tools and prototypes recently introduced include tools which have a plurality of different distal end portions which can be attached and removed from a single handle as desired to accomplish different functions. However, this arrangement requires repeated insertion and removal of the endoscopic tool through the trocar tube to the surgical area.
Accordingly, there remains a need for a device by which a combination suction-irrigation capability can be supplied to endoscopic tools, particularly to laparoscopic devices. Because it is desirable to minimize the placement and removal of endoscopic tools, it is advantageous to incorporate irrigation and aspiration capabilities in a device that will remain in place throughout an endoscopic procedure, to insert and remove the simplest, smallest devices possible, and to provide directional control for irrigation and aspiration capabilities so that they may be used with a variety of laparoscopic tools.